(Select All That Apply): A nurse is assessing a client for major depressive disorder (MDD). Which of the following signs and symptoms are consistent with the clinical presentation of MDD? Select all that apply.

Choice A rationale:

Bipolar disorder involves distinct periods of both elevated mood (mania or hypomania) and depressive episodes. The scenario describes persistent feelings of sadness, guilt, worthlessness, weight loss, and insomnia, which are characteristic symptoms of major depressive disorder (MDD) but not necessarily indicative of bipolar disorder.

Choice B rationale:

An adjustment disorder is characterized by emotional or behavioral symptoms that arise within three months of experiencing a stressor (e.g., a major life change or event). The persistent feelings of sadness, guilt, worthlessness, weight loss, and insomnia described in the scenario are beyond the typical time frame for an adjustment disorder.

Choice C rationale:

The correct answer. Major depressive disorder (MDD) is characterized by persistent feelings of sadness, loss of interest or pleasure, changes in weight or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating, and recurrent thoughts of death or suicide. The client's symptoms align closely with the diagnostic criteria for MDD.

Choice D rationale:

A normal response to stress usually involves transient feelings of sadness or anxiety in response to a stressor. However, the client's symptoms of persistent feelings of sadness, guilt, worthlessness, weight loss, and insomnia are indicative of a more serious and prolonged condition like major depressive disorder (MDD).

Choice A rationale:

Symptoms of major depressive disorder (MDD) are characterized by causing significant distress, not mild distress. The distress associated with MDD is usually severe and impairs daily functioning.

Choice B rationale:

While insomnia is a common symptom of major depressive disorder (MDD), it is not necessary for the diagnosis. Other symptoms, such as changes in appetite, psychomotor agitation or retardation, fatigue, and diminished interest or pleasure, can also contribute to the diagnosis.

Choice C rationale:

The correct answer. Symptoms of major depressive disorder (MDD) must not be due to a medical condition. It's crucial to rule out medical conditions that can mimic depressive symptoms, such as hypothyroidism or certain neurological disorders.

Choice D rationale:

The presence of a manic or hypomanic episode would indicate a diagnosis of bipolar disorder, not major depressive disorder (MDD). Bipolar disorder involves distinct periods of both elevated mood and depressive episodes.

Choice E rationale:

The correct answer. To meet the diagnostic criteria for major depressive disorder (MDD) according to DSM-5, an individual must experience five or more symptoms of depression during a continuous two-week period. These symptoms must include either depressed mood or loss of interest/pleasure. The scenario did not specify all the symptoms, but the persistent feelings of sadness, guilt, worthlessness, weight loss, and insomnia described align with the criteria.